antiemetic effects of midazolam added to fentanyl ropivacaine patient controlled epidural analgesia after subtotal gastrectomy a prospective randomized double blind controlled trial

CURRENT THERAPEUTIC RESEARCH V O I U M E 1, NU M nE R , O CTO RE R 10 Antiemetic Effects of Midazolam Added to FentanylRopivacaine Patient-Controlled Epidural Analgesia After Subtotal Gastrectomy: A Prospective, Randomized, Double-Blind, Controlled Trial Sioh Kim, MD , PhD I; Jeongwon Seo, MD I; and Younghoon J eon , MD, PhD2 1Department of A nesthesiology and Pain j'Hedicine, Kyungpook National University Hospital, Daegu, Republic of Korea; and 2Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea ABSTRACT BACKGROUND: N ausea and vomiting are frequ ent adverse effects of patientcont rolled epidural analgesia (PCEA) with opioids OBJECTIVE: This study was designed to assess th e ant iemetic effect of midazolam added to fent anyl-ropivacain e PCEA METHODS: In a prospectiv e, random ized, double-bl ind , cont rolled trial , smoking patients with gastric cancer undergoing elective subtotal gastrectomy were evenly allocated to I of treatm ent gro ups ro manage postoperati ve pain: 0.2% ropivacaine m ixed with fentanyl pg/rnl, and m idazolam 0.2 mg/mL (test g roup) or 2% ropivacaine mixed with fentan yl pg/rnl, (cont rol group) The PCEA infusion was set to deliver mLlh of the stud y solut ion, with a bolus of mL per demand and a IS-minute lockout time The incidence of postoper ati ve nausea and vom iti ng (PO N Y), pain intensity, sedation score, usage of rescue analgesia and rescue ant ieme tic, respiratory depre ssion, urinary retention , and pruritus were recorded at 2, 6, 12, 24 , 48, and 72 hours afrer surgery Total infused volume of PCEA at 72 hours after surgery was measured RESULTS: A total of 60 pati ents were approached and randomi zed to treatment N o patients were excluded by exclusion criteria and all enrolled patients completed this study Incidence of nausea (7% vs 33%; P = 02) in th e test group was significantl y lower than in the control g roup The overall freq uency of PONY in the test g roup was significantly less th an that of the control g roup (7% vs 40%; P = 0.006) In addit ion , the mean (SD) infused volume of PCEA in th e test group was significantly lower than that in th e cont rol group